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Registration 50 KM
Registration 50 KM
P
Paid
Pending
Q
Confirmed
Pending
M
Confirmed
Pending
No
BIB
Reg ID
Take your time to fill in this registration form as accurate as possible
Category
Race Experience
Tell us, at least one race that you have completed. For 170KM, 100KM, 65KM and 42KM, this will determine if you qualify to enter. Our Race Director will review your submission, and only after Approval (and Payment) your participation will be Confirmed.
Race Completed (1):
*
Details
*
*
*
-Type-
Road
Trail
Triathlon
Result
*
Race Completed (2):
Details
-Type-
Road
Trail
Triathlon
Result
Files Upload
Headshot Foto 1/2 Badan
*
Accepted file types: jpg, jpeg, png.
Upload your photo here, showing your face clearly. (Format: jpg|jpeg|png)
Passport/KTP Upload
*
Accepted file types: pdf, jpg, jpeg, png, gif.
Upload Passport/KTP (Format: pdf|jpg|jpeg|png|gif) IMPORTANT: We need this to apply for National Park Permit | Please Change Format Name KTP_yourID (example : KTP_3311122911950004.jpg)
KITAS Upload
Accepted file types: pdf, jpg, jpeg, png, gif.
Only for KITAS Holder (Format: pdf|jpg|jpeg|png|gif)
Race Result (1)
*
Accepted file types: pdf, jpg, jpeg, png, gif.
This is optional. Screenshot or e-certificate of your previous race result. (Format: pdf|jpg|jpeg|png|gif)
Race Result (2)
Accepted file types: pdf, jpg, jpeg, png, gif.
This is optional. Screenshot or e-certificate of your previous race result. (Format: pdf|jpg|jpeg|png|gif)
Personal Information
First Name
*
Last Name
*
Nationality
*
—
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint Martin
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Passport/KTP Number
*
Are you KITAS holder?
*
Yes
No
KITAS Number
*
Date of Birth
*
Date Format: MM slash DD slash YYYY
format: example: 1985-12-01 for 1 December 1985
Gender
*
-Gender-
Male
Female
Blood Type
*
—
O
O-
O+
A
A-
A+
B
B-
B+
AB
AB-
AB+
Event T-Shirt Size
*
T-Shirt Size
Extra Small
Small
Medium
Large
Extra Large
Correspondence & Residential Address
Email
*
Same email can only be used for one runner
Mobile Number
*
Example: +6281212345678, +622198765432 Please include country code and area code (if applicable)
Address Line 1
*
Address Line 2
City
*
State/Prov
*
Country
*
—
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint Martin
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Postal Code
*
Emergency Contact Name
*
In case of emergency, who should we contact?
Emergency Contact Number
*
Example: +6281212345678, +622198765432 Please include country code and area code (if applicable)
Origin
*
Indonesian/KITAS
Foreigners
Coupon
Registration Fee IDR
0
Date Format: MM slash DD slash YYYY
Agreement
*
I agree to the Terms of Service
IMPORTANT: This is very challenging trail race. By registering for this event, you have read and agree to the conditions stated in the
Terms and Condition, Rules & Regulations.
And you promise to train. Hard.
Payment Category
Regular
Payment type
–
Mandiri
Paypal
Visa/Mastercard
Free
Status
Pending
Duplicate
Confirmed
Fee amount
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